生物椎间融合器与钢板内固定系统置入对邻近颈椎间盘的影响  

Effect of cervical bioabsorbable cage versus plate systems on intervertebral disc adjacent to operated segments

作　　者：李宏伟[1] 鲍达[1] 葛彦虎[1] 赵铭[1] 孙继桐[1] 罗小波[1] 

机构地区：[1]解放军第309医院骨科,北京市100091

出　　处：《中国组织工程研究与临床康复》2010年第52期9823-9826,共4页Journal of Clinical Rehabilitative Tissue Engineering Research

摘　　要：背景:颈椎前路融合后邻近节段退变现象已引起临床重视,半弹性内固定系统可能较目前通用的坚强内固定对邻近颈椎间盘退变的影响小。目的:通过融合节段邻近颈椎间盘压力监测,在除外撑开强度影响的前提下,比较生物椎间融合器与钢板内固定系统置入对犬施术节段邻近颈椎间盘退变的影响。方法:选用健康杂种犬23只,按随机数字表法分为3组,其中预实验组5只,测量犬颈椎间盘压力正常参考值;生物可降解椎间融合器组9只;钢板置入内固定组9只。生物可降解椎间融合器组及钢板置入内固定组均经前路行C3～4椎间盘摘除,相应置入物置入内固定。术中测量邻近颈椎间盘C4～5压力,并计算置入前后C4～5椎间盘压力差作为撑开压力。置入后6个月处死动物,行Pearce分级及组织学观察,评价置入节段上位颈椎间盘(C2～3)退变程度。结果与结论:生物可降解椎间融合器组与钢板置入内固定组压力差的差异无显著性意义(P>0.05)。影像学及组织学检测结果显示,经Spearman等级相关分析,两组组内邻近颈椎间盘压力差与置入后6个月椎间盘退变Pearce分级、组织学分级均呈正相关(r=3.13,2.78,P<0.05)。生物可降解椎间融合器组椎间盘退变Pearce分级、组织学分级均低于钢板置入内固定组(P<0.05)。提示过高的撑开压力易导致犬置入节段邻近颈椎间盘退变,与钢板内固定系统相比,应用生物椎间融合器置入内固定可以有效防止邻近节段的退变。BACKGROUND：Adjacent segmental degeneration following cervical anterior fusion has become a focus. Semielastic internal fixation system exhibits less influences on adjacent intervertebral disc degeneration compared with commonly used rigid internal fixation systems. OBJECTIVE：Regardless of the intensity of brace,to investigate the effect of cervical bioabsorbable cage or plate systems on intervertebral disc adjacent to operative segments,by pressure monitoring on intervertebral disc adjacent to operative segments. METHODS：A total of 23 dogs of medical fitness were selected,and divided into 3 groups,including 5 in preliminary group （reference value of cervical intervertebral disc was measured）,9 in bioabsorbable cage group treated with bioabsorbable cage devices,and 9 in plate group treated with plate systems. All dogs underwent anterior discectomy on C3/4,and were implanted with corresponding internal fixators. The pressure of intervertebral disc adjacent to operative segment （C4/5） was measured in the operation. The pressure change from preoperative to postoperative was calculated as the intensity of brace. The animals were sacrificed at 6 months. Pearce grading and histological observation was performed to evaluate upper intervertebral disc degeneration. RESULTS AND CONCLUSION：There were no significant differences between bioabsorbable cage and plate groups in pressure change of intervertebral disc adjacent to operative segments （P 0.05）. Spearman analysis showed that pressure differences in group was positively correlated with Pearce grading,histological grading 6 months following implantation （r=3.13,2.78,P 0.05）. The intervertebral disc degeneration Pearce grading and histological grading were less in bioabsorbable cage compared with plate system group （P 0.05）. Results show that exorbitant brace pressure can induce the degeneration on dog＇s intervertebral disc adjacent to operative segments,and the degeneration was decreased using bioabsorbable cage devices compared with plate s

关 键 词：颈椎 邻近椎间盘 椎间融合器 内固定 钢板 

分 类 号：R318[医药卫生—生物医学工程]